胱氨酸结石患者的临床特点及其防治现状的研究

Study on the Clinical characteristics of Cystine Calculi and the Status Quo of Its Prevention and Treatment

目的探讨胱氨酸结石患者临床特点及其防治现状。方法收集胱氨酸结石的患者临床资料,回顾性分析患者既往病程并进行长程随访。结果共纳入16例患者,其中9例男性。首次结石发病年龄为(1.0~50.0)(20.00±15.31)岁。所有患者手术次数为(1.0~9.0)(3.00±2.19)次/人,外科干预后存在残石者发展为需再次外科干预间隔时间较外科干预后完全清石者短(21.89 vs 107.38个月,P=0.01)。手术次数≥3次者较≤2次者血清肌酐值明显升高(P=0.031),前者肾小球滤过率低于后者(P=0.134)。随机收集6例患者24 h尿液,测量显示尿胱氨酸浓度为(1027±709)mg/L,且浓度越高,结石负荷越大。所有患者确诊后均进行结石预防治疗,仅1例再次手术治疗。结论临床胱氨酸结石较少见,患者发病较早且容易复发,往往需要多次手术,术中应尽可能达到完全清石,术后应辅以药物治疗预防结石复发。

Objective To explore the clinical characteristics of cystine calculi and study the status quo of its prevention and treatment.Methods The clinical data of patients with cystine calculi were collected and their previous courses of diseases and the follow-up information were analyzed retrospectively.Results A total of 16 patients were included with 9 males and 7 females.The average age of the patients with the first onset of cysteine calculi was(20.00±15.31)years old and it ranged from 1.0 to 50.0 years old.The average numbers of operations in all the patients were(3.00±2.19)times per person and it ranged from 1.0 to 9.0 times per person.The interval time of reoperations in the patients with residual calculi after surgical intervention(21.89 months)was significantly shorter than that in the patients with complete calculus removal after surgical intervention(107.38 months)(P=0.01).The serum creatinine levels in the patients with no less than 3 operations was significantly higher than those in the patients with no more than 2 operations(P=0.031),and the glomerular filtration rate of the former was significantly lower than that of the latter(P=0.134).The urine was randomly collected in 6 patients within 24 hours,and the measurement results showed that the urine cystine concentration was(1027±709)mg/L.The urine cystine concentration increased with the increase of the calculus load.All the patients were educated with the knowledge of calculus prevention and treatment after diagnosis,and only 1 patient was treated with reoperation.Conclusion Cystine calculi are clinically rare.The onset of cystine calculi is relatively early and easy to recur in patients.Patients with cystine calculi often need multiple operations,so the cysteine caculi should be removed as much as possible during the operation and treated with drugs to prevent the recurrence of cystine calculi after the operation.